Method for predicting and monitoring response to an immune checkpoint inhibitor
A method for analyzing cell free DNA (cfDNA) from the bloodstream of a cancer patient is provided. In some embodiments, the method may comprise sequencing at least part of the coding sequences of TP53 and KRAS in a sample of the cfDNA, analyzing the sequences to identify nucleotide transversions in the coding sequences of the genes, relative to reference sequences of the genes. In some embodiments, the method may comprise counting the total number of identified nucleotide transversions. The presence of nucleotide transversions indicates that the patient will be more responsive to the immune checkpoint inhibitor, whereas a decreased number of transversions or no transversios indicates that the patient will be less responsive to the immune checkpoint inhibitor.
1. A method for treating a patient suffering from non-small cell lung cancer with an immune checkpoint inhibitor, wherein the method comprises:
(a) receiving a report indicating the results of a sequencing assay, wherein the sequence assay is capable of identifying, in cell-free DNA (cfDNA) from a blood sample from the patient: (i) sequence variations in at least TP53, KRAS, PTEN, STK11, EGFR and BRAF and (ii) rearrangements in at least of ALK and ROS1;
(b) identifying the patient as having one or more nucleotide transversions in the coding sequences of either TP53 or KRAS or in TP53 and KRAS, no predicted loss of function mutations in PTEN or STK11, no activating mutations in EGFR or BRAF and no rearrangements in ALK or ROS1; and
(c) administering an effective amount of the immune checkpoint inhibitor to the patient of step (b).
2. The method of claim 1 , wherein the report further comprises one or more treatment options.
3. The method of claim 2 , wherein the treatment options include PD-1/PD-L1 immune checkpoint blockade.
4. The method of claim 2 , wherein the treatment options include treatment with Ipilimumab, Nivolumab, Pembrolizumab, Atezolizumab, Avelumab or Durvalumab.
5. The method of claim 1 , wherein the report comprises a score indicating the likelihood of whether the patient will respond to the immune checkpoint inhibitor.
6. The method of claim 1 , wherein the immune checkpoint inhibitor administered in step (c) is an antibody.
7. The method of claim 6 , wherein the antibody is an anti-PD-1 antibody.
8. The method of claim 6 , wherein the antibody is an anti-PD-Ll antibody.
9. The method of claim 1 , wherein the sequencing assay is done by:
(i) amplifying the sequences of the genes in a multiplex PCR reaction in which at least 10 amplicons are amplified; and
(ii) sequencing the amplicons.
10. The method of claim 1 , wherein the sequencing assay comprises determining if there are any A to C transversions, determining if there are any C to A transversions, determining if there are any G to T transversions, determining if there are any T to G transversions, determining if there are any A to T transversions, determining if there are any T to A transversions, determining if there are any G to C transversions and determining if there are any C to G transversions in TP53 and KRAS.
11. The method of claim 1 , wherein the activating mutations in EGFR and BRAF comprise: G719X, exon19 deletions, V765A, T783A, V774A, S784P, L858R and L861X in EGFR and V600E; L601G; K601E; L597V/Q/R and G469V/S/R/E/A in BRAF.
12. The method of claim 1 , wherein the rearrangements in ALK and ROS1 comprise EML4-ALK, TFG-ALK, KIF5B-ALK, CD74-ROS1, SLC34A2-ROS1, SDC4-ROS1 and EZR-ROS1 fusions.